HOPWA GRANT PROGRAM APPLICATION PROJECT INFORMATION Project Sponsor: EIN Number: Contract Period: HOPWA Request: Address: City/State/Zip: Agency Director: (Area Code) Phone No.: HOPWA funding will not be available to pay costs incurred before July 1, 2019 and will provide funding for one year through June 30, 2020 unless otherwise stated by the City. 1. Provide a three or four sentence synopsis of your proposed program including a description of the service area in which you propose to work, the proposed housing and services, and the number of clients you intend to serve. 2. Briefly describe the proposed project including the eligible HOPWA activities for which funding is requested, the type of housing and/or housing related services proposed, the particular HIV/AIDS population to be served, the number of persons to be served by each activity and the term of the proposed funding. Please remember that the period of funding is ONE year from July 1, 2019 through June 30, 2020. 3. Describe the population to be served by the proposed HOPWA project including: a) their characteristics and needs for housing and supportive services; b) where they will come from; and c) outreach that will bring them into the project. The description must demonstrate that the population meets HUD's criteria for eligibility to receive HOPWA-funded services and housing. Additionally, you should describe the needs of the group that the project will serve indicating the type of housing and supportive services they will need. The description should
show that the project will be coordinated with services and housing provided by other service providers for persons with HIV/AIDS. 4. Describe the housing where the program participants will reside including: a) the type of housing (short-term supported housing facilities / emergency or transitional shelters, single room occupancy facilities, community group homes, privately owned homes or apartments, housing owned or leased by nonprofit agencies, etc.); b) the number of units of housing that will be provided; c) the number of individuals / households to be served; d) describe how you will ensure that the units will be accessible to persons with disabilities in accordance with applicable laws; e) describe any limits on a resident's length of stay; f) describe how the type, scale and other characteristics of the housing are appropriate for and meet the needs of the target population. 5. Describe any rental assistance the program participants will receive including: a) The type of rental assistance (tenant or project based rental assistance, rental assistance through master leasing of housing units, or short-term rent, mortgage and utility assistance); b) limits on the length or amount of rental support; and c) describe how the type and scale of rental assistance meets the needs of the target population. 6. Describe the supportive services that the participants will receive including: a) how the type (case management, job training, life skills training) and the scale (the frequency and duration of the services) will fit the needs of the participants; b) what agency will provide the supportive services, where they will be provided and what transportation will be available to the participants to access those services; c) how you plan to ensure that the participants will be individually assisted to identify and apply for and obtain benefits under mainstream health and social services programs for which they are eligible: TennCare, SSI, Food Stamp, and so forth; d) how the services will increase the participants' access to appropriate healthcare; and e) how the services will increase the participants access to employment 7. Describe how this project will be coordinated with other agencies that serve lowincome persons with AIDS. Include a brief description of your intake and referral process, how you share clients and coordinate services with other agencies. Please include in your answer a response to the following: Is your agency a participating member of the Mid-South Coalition on HIV/AIDS?
If your agency will serve the homeless, is your agency a participating member in the Community Alliance for the Homeless? If your agency will serve the homeless, does your agency provide data to Community Alliance for the Homeless for its Homeless Management Information System (HMIS) database on a regular basis? If your agency serves the homeless or provides services to prevent homelessness, how does your agency work with the Continuum of Care Network? 8. Describe how the proposed project will help the program participant establish and maintain stable on-going residency. 9. Describe how the proposed project will reduce the risks of homelessness for the proposed population. 10. Describe how the proposed project will ensure the program participant develops an individualized service plan and increases access to health care services. 11. Does your agency plan to acquire, repair or renovate existing housing or acquire a site for construction of new housing using HOPWA funds? If so, list the address and include a photograph of the building / site as well as documentation of site control. Or, is your agency leasing the structure to be renovated? If so, include a copy of the current lease. 12. Describe the experience your agency has in repairing / renovating or constructing new housing. List the experience of all entities involved in the planned project. 13. If you plan to use HOPWA funds to renovate or operate a shelter, will it be licensed? If so, by what agency and for what services? 14. If you plan to use HOPWA funds to construct a new SRO or community residence, or acquire and/or renovate housing for persons with HIV/AIDS, you must agree to operate those units for the appropriate use period dictated by HOPWA regulations. To ensure that you are able to manage / operate the housing, the City requires that you submit a management/operations plan for the use period. If your program proposes repairs or non-substantial rehabilitation, you must submit a three (3) year management / operations plan. You should provide a ten-year plan if you are
requesting funds for substantial rehabilitation (greater than 75% of the value of the property after rehab) or new construction of an SRO or community residence. 15. If you are requesting funds to operate a shelter, please provide a management /operation plan for the period of the proposed grant. Also, please describe the experience your agency has in operating a shelter or group housing project. 16. List staff members and positions currently employed by your agency that will be paid with HOPWA funds. Also attach resumes, job descriptions, and salaries as well as other information that demonstrate that the staff has appropriate credentials and experience to carry out the jobs. 17. List new staff positions that will be created to carry out the proposed project. Attach a copy of job descriptions, employment requirements, and proposed salaries for each new staff position to be funded through this grant. Job Titles Qualifications Proposed Salaries 18. If you are awarded HOPWA funds, how do you plan to fund/operate the project after they are spent? What long-range plans do you have for the project? Be specific. 19. If your project does not receive HOPWA funds, or receives less than you are requesting, are specific activities higher priorities for funding than others? Please list them beginning with the highest priority and associated budget amount. 20. Provide a schedule or timetable for implementing your project. Funds will be available on July 1, 2019.